The Health Shopper

 According to the Los Angeles Times, as many as 40 percent of 18 to 29 year olds are uninsured-a number that has been growing as students graduate and find jobs that often do not offer health benefits, or as people age out of their parents' health coverage. The Times notes that in most instances, younger people can find coverage on the individual market at reasonable rates. It also notes that for individuals with significant pre-existing conditions, many college alumni associations allow graduating students the opportunity to buy insurance through the alumni group.

The British National Health System has denied a cancer patient the right to pay for her own medication with her own money, spurring a debate there over what sorts of rights individuals have to pay for their own treatment. The 58 year-old breast cancer patient, Collette Mills, had been receiving treatment under England's state-sponsored system, but decided to pay for the drug Avastin-which is not covered by the NHS but which has been shown to improve outcomes for cancer patients-out-of-pocket.

Under the rules of the system, if she had paid for Avastin herself, she would have had to pay all costs associated with her cancer treatment, regardless of whether or not they would ordinarily be covered by the NHS. The government has defended its actions by saying that allowing people to use their own money to supplement state-sponsored treatment would create a "two-tiered system" for the rich and poor.

The case mirrors a case of a separate woman, Debbie Hirst, who also tried, unsuccessfully, to pay for Avastin with her own money to treat her cancer. The New York Times notes that Hirst's cancer has progressed, and in "a final irony Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all – paid for by the health service."

The Kaiser Family Foundation has an interesting white paper on the relationship between purchasing individual health insurance and income. Lower income individuals were much less likely than higher income people to buy health insurance, which is not much of a surprise. But even middle and upper income people were not terribly likely to purchase coverage. For example, the study found that among families not receiving coverage from an employer or from the government:

• Only one in four families earning between 400 and 449 percent of the federal poverty level had private coverage for at least six months out of the year.
• In no income bracket did a majority of families buy individual coverage. Among families who earned more than 1,000 percent of the federal poverty level, only 49 percent purchased coverage. When restricted to families with self-employed earners, who receive tax breaks for purchasing insurance, 58 percent of those with incomes above 1,000 percent of the poverty level bought coverage.
• Families earning at or below 300 percent of the federal poverty level were less likely than single adults or childless couples in that income bracket to purchase private coverage. Above that rate, however, families were more likely to buy insurance.

The report's authors did not spend much time exploring why so few people purchase insurance in the private market, although they do suggest "that many people… do not view coverage as attractive or do not feel that they can afford it."

California's health reform plan, which had been pushed heavily by Governor Arnold Schwarzenegger, was defeated this week due, in large part, to cost concerns particularly in the midst of a larger state budget crisis. Based largely on reform efforts in Massachusetts, the $14.9 billion plan would have required as many as 5.1 million state residents to purchase health insurance. The bill would have required insurers to sell health plans to anyone in the state, regardless of pre-existing conditions, and would have offered subsidies to lower income individuals to buy coverage.

Some observers believe that the defeat of the bill will discourage state level health reforms and encourage national plans. In contrast, the Los Angeles Times calls the defeat of the plan "a poor omen" for health care reform efforts put forth by Democratic presidential candidates Barack Obama and Hillary Clinton, which are broadly similar to the California bill.

A number of states, including New Mexico and California are following Massachusetts' lead by looking into individual insurance mandates as a means to create universal coverage.  While recent estimates suggest Massachusetts has dropped the ranks of the uninsured by 300,000 people, the state is now focusing on lowering costs to try to make insurance more affordable for the 400,000 or more residents who cannot afford insurance, focusing largely on reducing medical errors to limit hospital expenses and improving treatment for patients with chronic conditions, such as diabetes, and reducing the number of unnecessary diagnostic tests and scans.

America's Health Insurance Plans released a series of reform proposals to improve the individual insurance market. The proposal advocates that states create "Guaranteed Access Plans"-which would function similarly to high risk insurance pools-and in exchange, insurers would agree to cover anyone whose expected annual health costs do not exceed twice the state average. The proposal, which can be read in full here, would also require insurers to offer better coverage for pre-existing conditions and limit the ability of insurers to rescind policies.

HHS Secretary Michael Leavitt is the latest health expert to look to Holland for the solution to breaking the employer-based health insurance system while eliminating the ranks of uninsured. Leavitt will be visiting both the Netherlands and Switzerland, which require citizens to buy insurance or face financial penalties, and use subsidies to make costs manageable for lower income individuals.

Leavitt said that the Bush administration is not looking at proposing sweeping changes to the health care system at the moment. However, Senators Ron Wyden and Robert Barnett, a Democrat and a Republican, have introduceda bill to create individual mandates in the Senate. Similarly, Democratic Presidential candidates John Edwards and Hilary Clinton have both suggested reforms that largely mirror the Dutch model.

International Communications Research (ICR) just published the results of a survey that found consumers overwhelmingly believe greater emphasis on prevention is a solution to the nation's health care challenges. The poll, conducted in July, asked a nationally representative sample of U.S. adults a simple question: "What in your opinion are solutions to America's health care challenges?" 68.6 percent responded in favor of a national emphasis on preventive health services while 61.3 percent answered government-required health insurance for everyone.

Now, the health care system just needs to create incentives for prevention. As Arthur Agatston, the South Beach diet doctor, told the New York Times earlier this year, preventive medicine just doesn’t pay in the current American medical system. “The time we spend with patients — we get rewarded almost zilch."

The “Income, Poverty, and Health Insurance Coverage in the United States: 2006” report released this week by the U.S. Census Bureau shows that, while household income is up and the poverty rate are down, the number of people without health insurance has gone up by .5 percent. It was at 47 million in 2006. As the New York Times put it: "The main reason for the upsurge in uninsured Americans is that employment-based coverage continued to deteriorate. Indeed, the number of full-time workers without health insurance rose from 20.8 million in 2005 to 22.0 million in 2006, presumably because either the employers or the workers or both found it too costly."

But is insurance really unaffordable to the average American? A search of Vimo's database reveals that many insurance plans are available for less than $150 a month for a 30something male living in California. In fact, new affordable health insurance plans are being introduced on a regular basis by the major carriers. Granted, their deductibles are higher, but many of their premiums are low.

As filmmaker Stuart Browning reported in his short film "Uninsured in America," 17 million of the uninsured earn more than $50,000 a year. 9 million earn more than $75,000 a year. 18 million are young people that don't earn much but probably wouldn't have to pay much for insurance because they qualify as "young invincibles" — very healthy people in their 20s.

Individuals can afford health insurance. In fact, services like Vimo have made affordable health insurance just one quick phone call away.

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In the Wall Street Journal this week, Merrill Matthews, director of the Council for Affordable Health Insurance, points out that government controls on health care prices can hurt access. A planned 10 percent cut in Medicare payments to doctors threatens access to care. "A recent AMA survey found that 60% of responding doctors said they would stop accepting new Medicare patients if the 10% cut is imposed. Even if that figure is inflated by currently angry doctors, it could represent a significant decrease in seniors' access to care." As we pointed out in this earlier blog entry, price controls lead to much longer wait times and, in some cases, situations where doctors simply won’t see patients.